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Echocardiogram

Test Overview

An echocardiogram (also called an echo) is a type of
ultrasound test that uses high-pitched sound waves
that are sent through a device called a transducer. The device picks up echoes
of the sound waves as they bounce off the different parts of your heart. These
echoes are turned into moving pictures of your heart that can be seen on a
video screen.

The different types of echocardiograms are:

Transthoracic echocardiogram (TTE). This is the
most common type. Views of the heart are obtained by moving the transducer to
different locations on your chest or abdominal wall.

Stress echocardiogram. During this test, an
echocardiogram is done both before and after your heart is stressed either by
having you exercise or by injecting a medicine that makes your heart beat
harder and faster. A stress echocardiogram is usually done to find out if you
might have decreased blood flow to your heart (coronary artery disease).

Doppler echocardiogram. This test is used to look
at how blood flows through the heart chambers, heart valves, and blood vessels.
The movement of the blood reflects sound waves to a transducer. The ultrasound
computer then measures the direction and speed of the blood flowing through
your heart and blood vessels. Doppler measurements may be displayed in black
and white or in color.

Transesophageal echocardiogram (TEE). For this
test, the probe is passed down the
esophagus instead of being moved over the outside of
the chest wall. TEE shows clearer pictures of your heart, because the probe is
located closer to the heart and because the lungs and bones of the chest wall
do not block the sound waves produced by the probe. A
sedative and an
anesthetic applied to the throat are used to make you
comfortable during this test.

Echo can be used as part of a stress test and with an
electrocardiogram (EKG or ECG) to help your doctor learn more
about your heart.

Why It Is Done

Transthoracic echocardiogram (TTE)

This test is
done to:

Look for the cause of abnormal heart sounds
(murmurs or clicks), an enlarged heart, unexplained chest pains, shortness of
breath, or irregular heartbeats.

Check the thickness and movement
of the heart wall.

Look at the heart valves and check how well they
work.

See how well an artificial heart valve is
working.

Measure the size and shape of the heart's
chambers.

Check the ability of your heart chambers to pump blood
(cardiac performance). During an echocardiogram, your doctor can calculate how
much blood your heart is pumping during each heartbeat (ejection fraction). You might have a low ejection fraction if you have
heart failure.

Detect a disease that
affects the heart muscle and the way it pumps, such as
cardiomyopathy.

Look for blood clots and
tumors inside the heart.

A transthoracic echocardiogram may also be used
to:

Look for
congenital heart defects or to check the effectiveness
of previous surgery to repair a congenital heart defect.

Ask your doctor whether you should take your regular medicines as usual. Tell your doctor if you take insulin.

Transesophageal echocardiogram (TEE)

Do not eat or
drink for at least 6 hours before the TEE.

If you have dentures
or dental prostheses, you may need to remove them before the test.

If you have medical problems involving the throat, esophagus, or stomach, tell your doctor before getting this test.

Before a TEE, you will be given a sedative. You will not be able to drive
for at least 12 hours after the procedure. Be sure to make arrangements in
advance for someone to pick you up after the test.

Before an echocardiogram, you may be asked
to sign a consent form that says you understand the risks of the test and agree to have it done.

Talk to your doctor about any concerns you have
regarding the need for the test, its risks, how it will be done, or what the
results will mean. To help you understand the importance of this test, fill
out the
medical test information form(What is a PDF document?).

How It Is Done

An
echocardiogram may be done in a hospital, clinic, or
doctor's office. It can also be done at your bedside in the hospital.

You will need to remove any jewelry and clothes above your waist (you may
be allowed to keep on your underwear if it does not interfere with the test).
You may be given a cloth or paper covering to use during the test.

A transthoracic echocardiogram (TTE), Doppler echocardiogram, and stress
echocardiogram are performed by a specially trained ultrasound technician. A
transesophageal echocardiogram (TEE) is performed by a
cardiologist with the help of assistants.

You may receive
an IV so you can get medicine during the test. The IV can be used to give you a
contrast material, which helps
your doctor check your heart function. A contrast material may be used if it is difficult to
get good views of your heart. A good view might be hard to get because of certain conditions such as obesity or chronic
lung disease.

Transthoracic echocardiogram (TTE) and Doppler echocardiogram

You will lie on your back or on your left side on
a bed or table. Small metal discs (electrodes) will be taped to your arms and
legs to record your heart rate during the test. To learn more, see Electrocardiogram.

A small amount of
gel will be rubbed on the left side of your chest to help pick up the sound
waves. A small instrument (transducer) that looks like a microphone is pressed
firmly against your chest and moved slowly back and forth. This instrument
sends sound waves into the chest and picks up the echoes as they reflect off
different parts of the heart. The echoes are sent to a video monitor that
records pictures of your heart for later viewing and evaluation. The room is
usually darkened to help the technician see the pictures on the monitor.

At times you will be asked to hold very still, breathe in and out very
slowly, hold your breath, or lie on your left side. The transducer is usually
moved to different areas on your chest that provide specific views of your
heart.

The test usually takes from 30 to 60 minutes. When the test
is over, the gel is wiped off and the electrodes are removed.

Exercise stress echocardiogram

An echo without
activity or stress will be done before you start exercising. This is called the
baseline, and after it is established you will exercise for a specific amount
of time. You will either walk on a treadmill or pedal a stationary bicycle
while being monitored by an EKG machine. To learn more, see Exercise Electrocardiogram.

You will then
lie on a bed or table, and another echocardiogram will be done. At times you
will be asked to hold very still, breathe in and out very slowly, hold your
breath, or lie on your left side. The transducer is usually moved to different
areas on your chest that provide specific views of your heart.

An exercise stress echo takes about 30 to 60
minutes.

Dobutamine stress echocardiogram

Sometimes
medicine called dobutamine is used instead of exercise to stress your heart.
For this test, you will lie on your back or left side on a bed or exam
table, and a baseline echocardiogram will be done. EKG electrodes will be taped
to your arms and legs to record your heart rate during the test.

Next, the technician cleans the site on your arm where the medicine will
be injected, and an intravenous (IV) line will be placed in a vein in your
arm.

After the IV is started, you will be given dobutamine,
which increases your heart rate and causes your heart to work harder.
Echocardiogram images will be taken while you receive the dobutamine. Your peak
heart rate is reached in about 15 minutes. At times you will be asked to hold
very still, breathe in and out very slowly, hold your breath, or lie on your
left side. After your peak heart rate is reached, the medicine will be stopped
and your heart rate will return to normal (in about 1 to 3 minutes). More
echocardiogram images will be taken when your heart rate returns to
normal.

A dobutamine stress echo takes about an hour.

Transesophageal echocardiogram (TEE)

Before a TEE, your throat
may be numbed with an anesthetic spray, gargle, or lozenge to relax your gag
reflex and to ease insertion of the probe. Shortly before the procedure begins,
an IV line will be placed in a vein in your arm. Medicine to decrease saliva
and stomach secretions may be given through the IV. A pain medicine and
sedative will be given to you through the IV in your arm during the procedure.
You should feel relaxed and drowsy but still alert enough to cooperate.

Your heart rate, breathing rate, and blood pressure will be monitored
throughout the procedure. Also, a small device used to measure the amount of
oxygen in your blood (pulse oximeter) may be attached to your
finger or earlobe.

You will be asked to lie on your left side with
your head tilted slightly forward. A mouth guard may be inserted to protect
your teeth from the probe. Then the lubricated tip of the probe will be guided
into your mouth while your doctor gently presses your tongue out of the way.
You may be asked to swallow to help move the tube along. It may be helpful to
remember that the instrument is no thicker than many foods you swallow. When
the probe is in your esophagus, it will be moved down gently to the level of
your upper right heart chamber (atrium), and ultrasound images will be taken.
You will not feel or hear the sound waves during the test.

During the procedure, try not to swallow unless
requested. An assistant may remove the saliva from your mouth with a suction
device, or you can just let the saliva drain from the side of your mouth. A
transesophageal echo is generally painless, though you may feel nauseated and
uncomfortable while the probe is in your throat.

The test takes
about 2 hours. The probe will be in place in your esophagus for about 10 to 20
minutes.

How It Feels

Transthoracic echocardiogram (TTE) and Doppler echocardiogram

You will not have pain from the echocardiogram.
Gel is put on your chest for the ultrasound. It may feel cool. The handheld
ultrasound device is pressed firmly against your chest, but it does not cause
pain. You will not hear or feel the sound waves.

You may feel
uncomfortable from lying still or from the transducer pressing on your chest.
If you need to take a break, tell the technician.

Most
people do not experience any discomfort from ultrasound tests. But if you have
severe
difficulty breathing or cannot lie flat for a long
exam, you may not be able to have an entire echo study. Talk to your
doctor or the technician performing your echo about any concerns you
have.

Dobutamine stress echocardiogram

You may have a brief, sharp pain when the
intravenous (IV) needle is placed in a vein in your arm.

If
medicine to stress your heart is used, you may have symptoms of mild nausea,
headache, dizziness, flushing, or chest pain (angina). These symptoms only last
a few minutes.

Transesophageal echocardiogram (TEE)

During the test

You may notice a brief, sharp pain when the
intravenous (IV) needle is placed in a vein in your arm.

The
anesthetic sprayed into your throat may taste bitter and will make your tongue
and throat feel numb and swollen. Some people report that they feel as if they
cannot breathe at times because of the probe in their throat, but this is a
false sensation caused by the anesthetic. There is always plenty of breathing
space around the probe in your mouth and throat. Remember to relax and take
slow, deep breaths.

You may gag and feel nauseous, bloated, or have
mild belly cramps when the probe is moved. If the discomfort is severe, alert
your doctor with an agreed-upon signal or a tap on the arm. Even though you
won't be able to talk during the procedure, you can still
communicate.

The IV medicines will make you feel sleepy. Other side
effects—such as heavy eyelids, trouble speaking, a dry mouth, or blurred
vision—may last for several hours after the test. You probably will not be able
to remember much of the test.

After the test

You may have a tickling, dry throat; slight
hoarseness; or a mild sore throat. These symptoms may last for 2 to 3 days.
Throat lozenges and warm saltwater gargles can help relieve these symptoms.
Throat lozenges can be used by people age 4 or older. And most people can gargle at age 8 and older.

Do not drink alcohol for 24 hours.

Contact your doctor
immediately if you have:

Difficulty swallowing or
talking.

Shortness of breath or a fast heartbeat.

Chest
pain.

Risks

An echocardiogram is safe, because the test uses
only sound waves to evaluate your heart. These high-frequency sound waves have
not been shown to have any harmful effects.

If contrast material is used, there is a slight risk of having an allergic reaction. Most reactions can be controlled using medicine.

Transthoracic echocardiogram (TTE) and Doppler echocardiogram

There are no known risks from a transthoracic or
Doppler echocardiogram. During a transthoracic echo, the technician may have to
press hard on your chest with the transducer. Tell the technician if you feel
any pain or discomfort.

Transesophageal echocardiogram (TEE)

Insertion of the probe may tear or puncture your
esophagus. This is rare.

This test is not recommended if you
have:

Recently had
radiation treatment to your neck or
chest.

Serious problems with your esophagus, such as a very narrow
esophagus, dilated (engorged) veins in the esophagus that could rupture and
bleed (esophageal varices), or severe arthritis of your neck.

Trouble swallowing.

A bleeding disorder, such as
hemophilia.

Results

An echocardiogram is a type of
ultrasound test that uses high-pitched sound waves
that are sent through a device called a transducer. The device picks up echoes
of the sound waves as they bounce off the different parts of your heart. These
echoes are turned into moving pictures of your heart that can be seen on a
video screen.

Results are usually available within one day. If the
test is done by a cardiologist, the results may be available immediately after
the test.

Echocardiogram

Normal:

The heart chambers
and walls of the heart are of normal size and thickness, and they move
normally.

Heart valves are
working normally, with no leaks or narrowing. There is no sign of
infection.

The amount of
blood pumped from the left ventricle with each heartbeat (ejection fraction) is
normal.

There is no excess
fluid in the sac surrounding the heart, and the lining around the heart is not
thickened.

There are no tumors and blood clots in the
heart chambers.

Abnormal:

Heart chambers are
too big. The walls of the heart are thicker or thinner than normal. A thin
heart wall may mean poor blood flow to the heart muscle or an old heart attack.
A thin, bulging area of the heart wall may indicate a bulge in the ventricle
(ventricular aneurysm). The heart muscle walls do not move normally because of
a decreased blood supply from narrowed coronary arteries.

One or more heart valves do not open or
close properly (are leaking) or do not look normal. Signs of infection are
present.

The amount of
blood pumped from the left ventricle with each heartbeat (ejection fraction) is
lower than normal.

There is fluid
around the heart (pericardial effusion). The lining around the heart is too
thick.

A tumor or blood
clot may be found in the heart.

What Affects the Test

You may not be able to have the
test or the results may not be helpful if you are:

Overweight, have a thick chest or large
breasts, or have lung disease, such as chronic obstructive pulmonary disease
(COPD). In these situations, other heart tests may be done.

Not able to stand having a probe in your
throat during a transesophageal echo (TEE).

What To Think About

Sometimes doctors automatically schedule routine tests because they think that's what patients expect. But experts say that routine heart tests can be a waste of time and money. For more information, see Heart Tests: When Do You Need Them?

Other Places To Get Help

Organizations

American Heart Association (AHA)

Web Address:

www.heart.org

NIH: National Heart, Lung, and Blood Institute (U.S.)

TDD:

(240) 629-3255

Web Address:

www.nhlbi.nih.gov

References

Other Works Consulted

Cheitlin MD, et al. (2003). ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: Summary article: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). Circulation, 108(9): 1146–1162. Available online: http://circ.ahajournals.org/cgi/reprint/108/9/1146.

Douglas PS, et al. (2008). ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR 2008 Appropriateness Criteria for Stress Echocardiography: A Report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, American Society of Echocardiography, American College of Emergency Physicians, American Heart Association, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance: endorsed by the Heart Rhythm Society and the Society of Critical Care Medicine. Circulation, 117(11): 1478–1497. Available online: http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.189097.

Douglas PS, et al. (2010). ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography. Journal of the American College of Cardiology, 57(9): 1126–1166.

Lai WW, et al. (2006). Guidelines and standards for performance of a pediatric echocardiogram: A report from the Task Force of the Pediatric Council of the American Society of Echocardiography. Journal of the American Society of Echocardiography, 19(12): 1413–1430.

Mulvagh SL, et al. (2008). American Society of Echocardiography consensus statement on the clinical applications of ultrasonic contrast agents in echocardiography. Journal of the American Society of Echocardiography, 21(11): 1179–1201.

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